Do you think I need jaw surgery?

[Lastwish55]

Hi guys. I’m very new to this jaw surgery idea and all of the terms and measurement talk really doesn’t make much sense to me right now but I’m trying to educate myself.

I saw Dr. Hang for an appt. He suggested I undergo surgery but said I only can do it with his particular surgeon. It’s $50k without insurance so it’s not really an option for me right now.

I do think about it a lot. Especially the days when my shoulders hurt and I feel sluggish. I always wonder what life would be like with the proper airway and what I’m missing. However, I took a sleep study test at a lab and it seems I don’t even fit the criteria to have sleep apnea. So maybe it’s just a slight issue.

However, if I had the $50k there still is a tremendous amount of uncertainty still on if I should do it with all of the risks. I’m not really suffering like some others and my face is not super terrible.

Oh also—Dr. Hang suggested I see a myofunctional therapist to start. As well as look into the tongue tied surgery.

This is the email he wrote Incase you wanted to get a sense of what I’m dealing with. Honestly most of the measurements and terminology I don’t really understand but maybe you do.


Dear Joy,

I'm referring a very nice woman from Irvine to you for myo evaluation and treatment. She consulted with us last week regarding her chief complaint of fatigue. She has had ortho and fortunately without any teeth being extracted. Some of her muscles were tender to palpation but that was not her concern. She has a normal range of opening of the mandible. Her joints are both tender to palpation.

We did have a lateral head x-ray from 2013 which showed a very small airway then. She has seen Mark Cruz and tapes her lips at night and also uses a chin strap to keep her mouth closed. She has had a very hyper divergent growth pattern with both jaws falling back substantially from their ideal locations in her face. The maxillary central incisors are 51 mm. from the tip of her nose and should ideally be 36-40 mm. There really is no conservative (non-surgical) approach which would make any sense for her.  Some slight expansion of the maxilla from its current 34 mm. intermolar width will do very little to help the airway problem which is improved more with A-P changes. She is a perfect candidate for double jaw surgery to advance her forward, get her face height reduced and her chin forward, and open her airway. Lip closure at rest would be infinitely easier for her. This isn't going to be possible for her to do at least at this time. I believe that myo is her best option at this point.   Thanks for seeing her and for getting back to me.

Sincerely,

Bill


What would you do?

Any opinions/comments/suggestions would be greatly appreciated. :-)

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[Lastwish55]

Different angles

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[tim06]

Get a rhinoplasty, it is much less expensive and dangerous and it will also benefit your proportions regarding your lower third in the profile. I would absolutely not recommend you a jaw surgery.

[Framboise]

Hello  Lastwish55

As I'm french, I make mistakes in my post so don't think I'm retarded :-)

First of all, aestetically speaking, your fine.

Now, I woould like to know if you had underwent a test for your sleep apnea. If the answer is yes, what are the results ? Mild, moderate, severe ?

Did you have all your teeth or are you missing some teeth ? Do you have a good occlusion ? Do you wanna grind your teeth sometimes ?

If you feel a lot of discomfort, jaw surgery can be a solution but it means taking serious risks like infection. Besides the risk, jaw surgery will improve your profile but damage your nose (more or less) and your lips.
I think you are beautiful as you are and I won't do nothing, not even a genioplasty, because of the risks. I will undergo jaw surgery only if I had health issue. 

Don't hesitate to ask others surgeons opinion.

[kavan]

I agree that you are a good candidate for the bi-max surgery, BUT the contour diagram (black profile draw in next to your profile) proposal is TERRIBLE. So, try to find a max fax with better aesthetic sensibilities than the one who drew that contour diagram.

[ditterbo]

I agree that you are a good candidate for the bi-max surgery, BUT the contour diagram (black profile draw in next to your profile) proposal is TERRIBLE. So, try to find a max fax with better aesthetic sensibilities than the one who drew that contour diagram.

Good, I thought the same thing of that contour diagram. I also just found out my (medial pterygoid?) muscles are quite tender to palpation. No idea what that means - maybe overworked muscles. Sounds like its a risk factor for TMJ disorder.  "Tenderness in the facial muscles is a common finding in head and neck musculoskeletal disorders... Soft tissue dysfunction is treated with myofascial techniques, manual or acupuncture trigger point deactivation, muscle relaxation, and muscle re-education, where normal movement patterns are taught. Exercises to decrease masticatory muscle activity and, hence, TMJ loading are taught " Could be totally wrong, cursory google search.  Now it's hard to 'unnotice' a strange/mild ache in that area upper back of the mouth.

[kavan]

Good, I thought the same thing of that contour diagram. I also just found out my (medial pterygoid?) muscles are quite tender to palpation. No idea what that means - maybe overworked muscles. Sounds like its a risk factor for TMJ disorder.  "Tenderness in the facial muscles is a common finding in head and neck musculoskeletal disorders... Soft tissue dysfunction is treated with myofascial techniques, manual or acupuncture trigger point deactivation, muscle relaxation, and muscle re-education, where normal movement patterns are taught. Exercises to decrease masticatory muscle activity and, hence, TMJ loading are taught " Could be totally wrong, cursory google search.  Now it's hard to 'unnotice' a strange/mild ache in that area upper back of the mouth.

I believe I've found the Dr. Hang mentioned here along with same/similar contour diagram. He is an orthodontist.

Aside from the terrible contour diagram, he does kind of appear 'with the program' in so much he is advocate of orthotropics, Mike Mew sort of thing where he's against removing teeth or pushing the face back and down with braces just to get the 'bite right'. So, he's one of the ortho docs who 'gets it' as to NOT do stuff to make the face look WRONG to get the bite RIGHT.

If I were the OP and told to 'only do surgery with his particular surgeon', I would want to establish if his particular surgeon was one to aspire to an outcome similar to that terrible contour diagram. If so, I'd run.

[Tati]

So, he's one of the ortho docs who 'gets it' as to NOT do stuff to make the face look WRONG to get the bite RIGHT.

Could you expand on this point? ..

[kavan]

Could you expand on this point? ..

from my prior post:  "....he's against removing teeth or pushing the face back and down with braces just to get the 'bite right'. "

[Lefortitude]

i think ur very pretty, but you would be a sure candidate for bimax to get the jaws right and the airway opened.  Bill hang is polarizing.  I would recommend getting a second opinion from another orthodontist.  I assume youre in southern california. there are a million excellent orthos there.  You can even consult with gunson and see what he thinks.

[GJ]

Bill hang is polarizing.

I had a consult schedule with him but never went due to some red flags on the phone call.
I'd never get involved with him, but he is correct not to extract teeth, so he has that going for him.

[Tati]

from my prior post:  "....he's against removing teeth or pushing the face back and down with braces just to get the 'bite right'. "

Yeah, but for what reasons do you think or know it's a bad idea..

[kavan]

Yeah, but for what reasons do you think or know it's a bad idea..

You mean to tell me you're not familiar with the problem of someone having an overbite and orthos pushing that backwards and plucking pre molars to do it in order to match the RETRUSIVE mandible?

[Tati]

Yes, but for example, I had a pair of bicuspids removed to worsten my underbite which allowed the surgeon to advance more.

I wasn't thinking of camouflage to avoid a surgical procedure..

[kavan]

Yes, but for example, I had a pair of bicuspids removed to worsten my underbite which allowed the surgeon to advance more.

I wasn't thinking of camouflage to avoid a surgical procedure..

The concept is most applicable to people who have an OVERBITE (usually kids) where the real situation is RETRUSIVE mandible where the ortho wants to 'save them' from a maxfax surgery and just get the 'bite right'. To THAT regard the ortho removes pr molars in order to push the front teeth BACK to match the RETRUSION of the lower jaw whereas what is best done is to use devices to move the LOWER jaw forward.

I'm not referring to situations where people need to have the pre molars removed in order to make space to bring a jaw forward in a bi max advancement.